Stab me once, shame on you. Stab me twice, shame on me. Stab me three times and you’d better run ‘cause I’m comin’ after you…Such was the situation after Nurse Joe was unable to insert the IV into my hand, then my wrist, then my forearm. Mind you, my veins are raised like Braille; a raised-relief hematologic map. After his first stab at it, I got the feeling that Pin the Tail on the Donkey without a blindfold might be a problem for this guy. And I, currently the aforementioned donkey, had had about enough random skewering for one day. Sensing from my glare that he was in impending danger, he wrapped things up and said he would leave the task to the anesthesiologist. He just wasn’t having a good day.

And given that my day had started at 4:30am without coffee or breakfast, neither was I. Nurse Joe, a burly bearded man who looked way more like a country bartender than a nurse, packed up his IV kit and retreated down the hallway. He returned with some ice packs for my punctured right arm, now covered in gauze bandages. He then turned his attention to my left hand, still adorned with my wedding band. I had attempted to remove it prior to leaving for the hospital, however, after twenty-five years my finger had grown around it like tree roots around pavement. Given his lack of concern for concepts such as: First, do no harm, I gave him my dagger eyes and firmly stated, “It’s not coming off”.

Joseph Nightingale, undeterred by my negative energy, had “an idea” and wandered off again. This time he returned with a handful of string, possibly dental floss, which he threaded through my ring and began to wind tightly around my finger. “Have you ever seen this trick?” he asked.

Bartender, a shot please…

I had most definitely NOT ever seen this trick; especially the part where, abracadabra, my finger was turning purple and the string was cutting through my skin.

“Ow!” I yelled as he began to unwind the string from the bottom, trying to force the ring up and over the bound area. “Ow”, unfortunately, was not the magic word to make the bad man stop. “F##k, you’re killing me!” was not either. You might have thought at least one person would have pulled the curtain back just a tad to make sure I was okay, but no, my outbursts elicited no reaction from anyone, including my husband who sat quietly beside me as Nurse Joe proceeded to wedge the ring over my knuckle where he reached an impasse.

“Huh” he said, “this trick usually works”.

Huh.

Surely he would push the ring back down into its place now, you know, before he dislocated my finger.

“You got to know when to hold up, know when to fold up, know when to walk away, know when to run…”

But Nurse Joe was no quitter. No sir, he just kept tugging, and I daresay had that ring not finally ripped over the knuckle and off, he would sooner have tied the string to the back of his Chevy pickup than given up.

Satisfied with his successful “trick”, he handed me a cupful of pre-op pills, and wished me good luck on my surgery. I gave him a final scowl and slumped back in my recliner, placing another ice pack over my ring finger, now the girth of my thumb.

By the time I got to the operating table, I was just thankful to lie down and be put out like an old injured racehorse.

This day was a long time in the making. Nearly two years ago, my mother was diagnosed with stage 4 pancreatic cancer with a metastasis to her liver. Her tumors were inoperable and her diagnosis terminal. The doctors advised us that most patients at this stage would live only three to six months without treatment, perhaps an extra two or three with traditional chemotherapy.

The diagnosis took us all by surprise. My mother was unequivocally the healthiest person we knew. After a lifetime of exercise and a healthy diet, she was fit and strong and appeared decades younger than her 72 years. But her cancer cared not about her lifestyle. The disease surfaced from a defect in her genetic code. As a woman of Ashkenazi Jewish descent, with a family history of ovarian and pancreatic cancer, there was reason to believe her cancer was hereditary. Her genetic testing confirmed a mutation in the BRCA2 gene. The genes,BRCA1andBRCA2,are involved in cell growth, cell division, and the repair of damage to DNA. Mutations in these genes can cause DNA damage to go unrepaired, increasing the risk of developing certain cancers. Breast and ovarian cancer are the most common, but there is also an increased risk for colon cancer, prostate cancer, melanoma and pancreatic cancer (For more information, see https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-genetics/genetic-counseling/inherited-risk-breast-ovarian).

Miraculously, my mother is still alive and battling her pancreatic cancer some twenty months after it was discovered. Despite her petite frame and ever-diminishing weight, hers is a strength and grace I have never witnessed in another human being. Her quality of life is generally good for someone in the advanced stages of this deadly disease. But it is unquestionably a day-to-day struggle, fraught with exhaustion, fear, and physical deterioration as the cancer continues to menace from within. Nevertheless, she manages to climb out of bed long enough to hit the gym, spend time with her family and friends and engage in artistic projects. My mother is a tiny, radiant diamond shining in a dark mine; a guiding light by which we are all inspired and driven to carry on and embrace life in any and every way that we can.

After her diagnosis, my mother’s genetic counselor suggested that I also get tested for the BRCA gene since there was a 50% chance that I would have inherited the same genetic mutation. I was not the slightest bit surprised that I, too, tested BRCA2 positive, as for all intents and purposes, I am a clone of my mother. The action to take after your genetic makeup is revealed is a matter of personal choice. Some women choose to do nothing more than keep a watchful eye on their health. You may recall that in recent years, actress Angelina Jolie decided to have a bi-lateral mastectomy and oophorectomy (removal of the ovaries and fallopian tubes) after testing positive for BRCA1. The risk factors of BRCA1 and BRCA2 are nearly the same: Women with these mutations are about 85% more likely to have breast cancer, about 25% more likely to develop ovarian cancer, and about 8% more likely to develop pancreatic cancer (than someone who does not have the BRCA gene mutation).

As I came to learn, there is little that can be done to prevent or pre-screen for pancreatic cancer. It is considered one of the most virulent cancers, affecting over 46,000 people a year, with over 39,000 succumbing to the disease each year and only 5% living to five years. Typically, as was the case with my mother, the cancer is not discovered until the patient is in the end stages of the disease. The best testing currently available to detect early pancreatic cancer is an MRI or upper endoscopy though neither can detect the cancer until it exists. I have opted to be in a study at Columbia University Hospital that provides annual testing, alternating between MRI and endoscopy, in an effort to be as proactive as possible.

Addressing the high risk of breast cancer has more options. For many women, a breast MRI alternated with a mammogram every six months is sufficient to put their minds at ease in detecting the early signs of breast cancer. Screening and treatments for breast cancer have improved vastly in recent years, allowing women the option to address the issue if and when it arises. For me, however, the concept of having any cancer, for even a minute, does not sit well. I never want to have the conversation with a doctor in which he says, “Good news, we caught it early!” Early is just too late for me. I am in the process of scheduling a prophylactic bi-lateral mastectomy, which will as nearly as possible eliminate the potential for that scenario.

But this week’s visit to the hospital was to address my risk of ovarian cancer, a disease for which there is no reliable prescreening, treatment or cure. The prophylactic solution is to remove the ovaries and fallopian tubes. This, of course, is a big decision for any woman, but particularly for those who still wish to have children. I am fortunately well beyond that stage. My children are already in their early twenties and I am in the midst of perimenopausal hot flashes. This is an easy choice for me. Eggs out. Final answer.

During my appointment with an oncological gynecologist, he explained the procedure and what to expect after the surgery. I would be out under general anesthesia. My ovaries and fallopian tubes would be removed laparoscopically through four small incisions in my abdomen. My uterus would be left intact since BRCA2 is not generally linked to uterine cancer. Cell samples would be biopsied during the procedure to insure that no cancer was already present. If testing were normal, I would be closed up and sent home the same day, advised to “take it easy” for two weeks and refrain from vigorous exercise for six. This occurred to me like a punitive sentence, but I quickly gained perspective when I was told that because I had two previous C-sections, there was a possibility that the surgery would have to be an open incision. This alternative would mean an incision similar in size and location to my C-sections, and would warrant a two-night stay in the hospital and two months of recovery at home (Read: no exercise, emotional hysteria, violent outbursts).

While I had no hesitation about having the procedure, I was filled with trepidation about the downtime afterward. For some people, a doctor saying “take it easy” for a few weeks, even months, is a hall pass to skip class. But for me, being physically active and fit is a vital source of my mental stability (well, can you even imagine how much worse I’d be if this is what I consider stabile?). It is also my job, my source of income and a big part of my identity. The thought of not being able to do what I love, what keeps my head from spinning around like The Exorcist, just near about knocked me over. I had to keep reminding myself that this was not about looking or even feeling good. This was about doing everything I could to avoid developing ovarian cancer. This was about following my mother’s bright light, carrying on and embracing life in any and every way that I could. And with that, I set my surgery date.

Today is three days post-op. My surgery went well, which is to say, the procedure was laparoscopic (I had a womb with a view!) and the biopsy revealed no sign of cancer. I went home to recover just a few hours after surgery. The discomfort of the four new incisions on my abdomen far overshadows the three failed IV stab wounds of the morning. Since the surgery, my abdomen has been blown up and out. Today, in my yellow oversized shirt, I look very much like Sponge Bob Square Pants. My belly obscures my view of everything including, on occasion, common sense. I’ve had some moments of concern that my six-pack, now replaced by a keg, is gone forever. For a second, I toyed with changing my business name to Fatness By Loren.

Fortunately though, these moments pass quickly. There is nothing quite like watching someone you love battling cancer to remind you of what really matters; that health and fitness are about so much more than a bikini body. I have been knocked out physically before and found a way back. In the scheme of things, my discomfort is just a little nuisance, not a calamity. It may be cliché, but it’s simply true that life is too precious and limited to wallow here. And so, I will use this “take it easy” time to take in what’s really important—that my mother is still alive, that I have no cancer, that I had no surgical complications, that I am home with my family and friends—that I had my eggs over easy with just a side of achin’.

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Loren Martz

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